Robert May memorial lecture: Advances in reconstructive venous surgery.

During the last decade progress in reconstructive venous surgery is mainly based on improvements of preoperative diagnosis and on changed surgical techniques (e.g. intraoperative lumen control by vascular endoscopy or angiography; temporary arteriovenous fistulas as protective measure; external supported vascular prostheses as substitutes). The main indications include acute ilio-femoral phlebothrombosis, vein injuries and in selected cases the substitution of big veins in extended tumor surgery. The late results of venous thrombectomy in the ilio-femoral segment could be remarkably improved due to changed techniques of lumen restoration (combined ring- and balloon-disobliteration, temporary a.v. fistula in inguinal or popliteal position). In patients with persisting central occlusions in the iliac veins a second repair may be considered using a suprainguinal cross-over graft (external supported e-PTFE-prosthesis). For post-thrombotic syndrome with pronounced deep venous insufficiency reconstructive procedures afford a critical selection of patients (Palma-operation, Husni-May-operation, interposition of valve bearing venous segments in the superficial femoral vein). The remarkable contribution given by R. May to the advances in venous surgery is illustrated.